South Carolina summers pose risks for city employees working long hours in the heat. The danger can be reduced with appropriate rest, shade and fluid intake, and there are even electrolyte popsicles and drinks that can reduce heat stress illnesses. Training staff to recognize heatstroke is also a critical precaution.
The traditional definition of heatstroke includes confusion, unconsciousness and convulsions, accompanied by a lack of sweating. Even so, this type of heatstroke is not the type that most commonly strikes workers. The National Institute for Occupational Safety and Health now indicates that "exertional heatstroke" is more common in workers — and profuse sweating is, in fact, one of its symptoms.
Exertional heatstroke comes from a combination of heat exposure and heavy physical exertion. It can lead to a condition called rhabdomyolysis. Symptoms of rhabdomyolysis include muscle pain and cramping, swelling, weakness and decreased range of motion. Fatigue, abdominal pain, back pain, nausea or vomiting and confusion may also occur. However, many cases occur with very mild symptoms that are mistaken for heat stress. This creates a potentially dangerous situation because these workers don't receive the intensive medical intervention they require.
Another potential complication of rhabdomyolysis is compartment syndrome, or swelling in a specific type of muscle, usually in the lower extremities, that blocks blood flow. Compartment syndrome is often delayed — it may take several hours to develop — and can lead to permanent loss of function in the affected limb.
Symptoms of compartment syndrome include pain, pallor and pulselessness. They also include paresthesia — a sensation of tingling, numbness, or burning, usually felt in the hands, feet, arms or legs — and paralysis. Pain is the most common symptom and tends to be extremely severe. Workers who experience these symptoms must go to a hospital immediately.
Both types of heatstroke come with extremely high body temperature, and both types are a medical emergency requiring immediate medical attention. First aid includes cooling the worker as quickly as possible by any means available, including an ice bath, circulating air around the worker, and placing cold packs on the head, neck, armpits and groin. For exertional heatstroke, oral hydration is vital.
The Occupational Safety and Health Administration has a heat safety webpage with helpful resources, including a heat safety app.